Enumeration of Hypermaps of a Given Genus

This paper addresses the enumeration of rooted and unrooted hypermaps of a given genus. For rooted hypermaps the enumeration method consists of considering the more general family of multirooted hypermaps, in which darts other than the root dart are distinguished. We give functional equations for the generating series counting multirooted hypermaps of a given genus by number of darts, vertices, edges, faces and the degrees of the vertices containing the distinguished darts. We solve these equations to get parametric expressions of the generating functions of rooted hypermaps of low genus. We also count unrooted hypermaps of given genus by number of darts, vertices, hyperedges and faces.Comment: 42 page

Red cell transfusion triggers in critically ill patients: time for some new TRICCs?

Current evidence suggests that critically ill patients tolerate anaemia well and that blood transfusions may increase the risk of adverse outcomes. Dr Sakr and colleagues present a contradictory analysis of a surgical ICU cohort, finding an association between blood transfusions and lower hospital mortality after adjustment for a range of potential confounders. Analyses of this kind are interesting and provocative, but are limited by residual confounding and bias by indication. The data emphasise the need for additional high quality trials of transfusion practice in critical care

SOUTHERNMOST OCCURRENCE OF THE SUWANNEE COOTER, PSEUDEMYS CONCINNA SUWANNIENSIS (TESTUDINES: EMYDIDAE)

The Suwannee Cooter, Pseudemys concinna suwanniensis, the largest member of the speciose turtle family Emydidae, inhabits a small number of rivers that drain into the northeastern Gulf of Mexico along the northwest coast of Florida from just west of Tallahassee to just south of Tampa. The status of this state-protected subspecies in the southernmost of these rivers, the Alafia, is unknown and hence of conservation concern. We provide recent evidence confirming that a reproducing population still exists in this river, and review available specimens and both published and unpublished records documenting the southern limit of distribution. At least within the eastern United States, our observations also extend confirmed knowledge of the geographic occurrence of hatchling turtles overwintering in the nest southward by 285 km

A novel computerized test for detecting and monitoring visual attentional deficits and delirium in the ICU

Objectives: Delirium in the ICU is associated with poor outcomes but is under-detected. Here we evaluated performance of a novel, graded test for objectively detecting inattention in delirium, implemented on a custom-built computerized device (Edinburgh Delirium Test Box–ICU). Design: A pilot study was conducted, followed by a prospective case-control study. Setting: Royal Infirmary of Edinburgh General ICU. Patients: A pilot study was conducted in an opportunistic sample of 20 patients. This was followed by a validation study in 30 selected patients with and without delirium (median age, 63 yr; range, 23–84) who were assessed with the Edinburgh Delirium Test Box–ICU on up to 5 separate days. Presence of delirium was assessed using the Confusion Assessment Method for the ICU. Measurements and Main Results: The Edinburgh Delirium Test Box–ICU involves a behavioral assessment and a computerized test of attention, requiring patients to count slowly presented lights. Thirty patients were assessed a total of 79 times (n = 31, 23, 15, 8, and 2 for subsequent assessments; 38% delirious). Edinburgh Delirium Test Box–ICU scores (range, 0–11) were lower for patients with delirium than those without at the first (median, 0 vs 9.5), second (median, 3.5 vs 9), and third (median, 0 vs 10.5) assessments (all p < 0.001). An Edinburgh Delirium Test Box–ICU score less than or equal to 5 was 100% sensitive and 92% specific to delirium across assessments. Longitudinally, participants’ Edinburgh Delirium Test Box–ICU performance was associated with delirium status. Conclusions: These findings suggest that the Edinburgh Delirium Test Box–ICU has diagnostic utility in detecting ICU delirium in patients with Richmond Agitation and Sedation Scale Score greater than –3. The Edinburgh Delirium Test Box–ICU has potential additional value in longitudinally tracking attentional deficits because it provides a range of scores and is sensitive to change

Resuscitation of the trauma patient: tell me a trigger for early haemostatic resuscitation please!

The management of trauma-related coagulopathy and haemorrhage is changing from a reactive strategy to a proactive early intervention with blood products and haemostatic agents. Although major haemorrhage and massive transfusion are associated with higher mortality, the pattern of this association with modern trauma care is poorly described. In addition, early predictors of massive transfusion, which might trigger a proactive haemostatic resuscitation strategy, are not currently available. We review recent literature relating to predictors of massive transfusions and the relationship between transfusion and mortality